Public Act 097-0426
 
SB2046 EnrolledLRB097 10049 KTG 50225 b


  
    AN ACT concerning public aid.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  
 
 
    Section 5. The Illinois Public Aid Code is amended  by 
changing Section 5-5.12 as follows:
 



    (305 ILCS 5/5-5.12)  (from Ch. 23, par. 5-5.12)



    Sec. 5-5.12. Pharmacy payments. 

    (a) Every request submitted by a pharmacy for reimbursement 
under this
Article for prescription drugs provided to a 
recipient of aid under this
Article shall include the name of 
the prescriber or an acceptable
identification number as 
established by the Department.

    (b) Pharmacies providing prescription drugs under
this 
Article shall be reimbursed at a rate which shall include
a 
professional dispensing fee as determined by the Illinois

Department, plus the current acquisition cost of the 
prescription
drug dispensed. The Illinois Department shall 
update its
information on the acquisition costs of all 
prescription drugs
no less frequently than every 30 days. 
However, the Illinois
Department may set the rate of 
reimbursement for the acquisition
cost, by rule, at a 
percentage of the current average wholesale
acquisition cost.

    (c) (Blank).

    (d) The Department shall not impose requirements for prior 
approval
based on a preferred drug list for anti-retroviral, 
anti-hemophilic factor
concentrates,
or
any atypical 
antipsychotics, conventional antipsychotics,
or 
anticonvulsants used for the treatment of serious mental

illnesses
until 30 days after it has conducted a study of the 
impact of such
requirements on patient care and submitted a 
report to the Speaker of the
House of Representatives and the 
President of the Senate. The Department shall review 
utilization of narcotic medications in the medical assistance 
program and impose utilization controls that protect against 
abuse. 

    (e) When making determinations as to which drugs shall be  
on a prior approval list, the Department shall include as part 
of the analysis for this determination, the degree to which a 
drug may affect individuals in different ways based on factors 
including the gender of the person taking the medication. 
    (f) The Department shall cooperate with the Department of 
Public Health and the Department of Human Services Division of 
Mental Health in identifying psychotropic medications that, 
when given in a particular form, manner, duration, or frequency 
(including "as needed") in a dosage, or in conjunction with 
other psychotropic medications to a nursing home resident, may 
constitute a chemical restraint or an "unnecessary drug" as 
defined by the Nursing Home Care Act or Titles XVIII and XIX of 
the Social Security Act and the implementing rules and 
regulations.  The Department shall require prior approval for 
any such medication prescribed for a nursing home resident that 
appears to be a chemical restraint or an unnecessary drug.  The 
Department shall consult with the Department of Human Services 
Division of Mental Health in developing a protocol and criteria 
for deciding whether to grant such prior approval. 
    (g) The Department may by rule provide for reimbursement of 
the dispensing of a 90-day supply of a generic or brand name, 
non-narcotic maintenance medication in circumstances where it 
is cost effective. 
(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10; 
96-1501, eff. 1-25-11.)